The type 2 inflammatory response favors recognition of tumor antigens by IgE in breast cancer.

BACKGROUND: Several studies describe an inverse statistical relationship between the presence of an allergy and development of cancer. However, the immunological mechanism involved in the relationship between these two degenerative diseases has not been explored. AIMS: The main objective of this study was to explore the possibility that the lymphocyte T helper (Th) 2 response, a characteristic of allergy, induces recognition of tumor antigens. METHODS AND RESULTS: Patients with a clinical diagnosis of breast ductal carcinoma were included. Histopathological markers related to proliferation of tumor cells were determined (Her-2-neu, Ki-67, estrogen receptor, and progesterone receptor). IHC was performed using IgE antibodies purified from an allergy patient and from each biopsy donor patient. Serum concentrations of cytokines representative of Th1 and Th2 inflammatory responses were determined. A total of 14 patients with a confirmed diagnosis of breast ductal carcinoma were included. IHC performed on biopsies showed a weak response when using purified IgE antibodies from an allergy patient; however, IHC using the IgE of each patient as the primary antibody showed an intense and highly specific signal. Serum concentrations of cytokines of the Th2 response, that is, IL-4 (130.5 pg/mL (116-135 pg/mL)), IL-5 (202 pg/mL (191-213 pg/mL)), and IL-13 (105.5 pg/mL (98-117 pg/mL)), were significantly higher than those of the Th1 response, that is, IL-6 (86 pg/mL (79-90 pg/mL)) and INF-γ (93 pg/mL (79-99 pg/mL)). CONCLUSION: Purified IgE antibodies specifically recognize tumor cells in breast ductal carcinoma.

Regional moderate hyperthermia for mild-to-moderate COVID-19 (TherMoCoV study): a randomized controlled trial.

Background: To prevent COVID-19 progression, low-cost alternatives that are available to all patients are needed. Diverse forms of thermotherapy have been proposed to prevent progression to severe/critical COVID-19. Objective: The aim of this study is to evaluate the efficacy and safety of local thermotherapy to prevent disease progression in hospitalized adult patients with mild-to-moderate COVID-19. Methods: A multicenter, open-label, parallel-group, randomized, adaptive trial is used to evaluate the efficacy and safety of local thermotherapy to prevent disease progression in hospitalized adult patients with mild-to-moderate COVID-19. Eligible hospitalized adult patients with symptoms of COVID-19 with ≤5 days from symptom onset, meeting criteria for mild or moderate COVID-19, were randomly assigned to the intervention consisting of local thermotherapy via an electric heat pad in the thorax (target temperature range 39.5­42°C) continuously for 90 min, twice daily, for 5 days, or standard care. The main outcome was the proportion of patients who progressed to severe-to-critical COVID-19 or death. Patients were randomized in a 1:1 ratio through a centralized computer-generated sequence of minimization with a random component of 20%. Participants and medical staff were not blinded to the intervention. Results: One-hundred and five participants (thermotherapy n = 54, control n = 51) with a median age of 53 (IQR: 41­64) years were included for analysis after the early cessation of recruitment due to the closure of all temporal COVID-19 units (target sample size = 274). The primary outcome of disease progression occurred in 31.4% (16/51) of patients in the control group vs. 25.9% (14/54) of those receiving thermotherapy (risk difference = 5.5%; 95%CI: −11.8­22.7, p = 0.54). Thermotherapy was well tolerated with a median total duration of thermotherapy of 900 (IQR: 877.5­900) min. Seven (13.7%) patients in the control group and seven (12.9%) in the thermotherapy group had at least one AE (p = 0.9), none of which were causally attributed to the intervention. No statistically significant differences in serum cytokines (IL-1ß, IL-6, IL-8, IL-10, IL-17, and IFN-γ) were observed between day 5 and baseline among groups. Conclusion: Local thermotherapy was safe and well-tolerated. A non-statistically significant lower proportion of patients who experienced disease progression was found in the thermotherapy group compared to standard care. Local thermotherapy could be further studied as a strategy to prevent disease progression in ambulatory settings.Clinical Trial registration: www.clinicaltrials.gov, identifier: NCT04363541.

[Prosopis spp. in allergic diseases]. / Prosopis spp. en enfermedades alérgicas.

OBJECTIVES: To demonstrate cutaneous reactivity and the participation of Prosopis pollen in patients with allergic diseases who attend the Allergy and Clinical Immunology Service of the General Hospital of Mexico, in Mexico City. METHODS: A retrospective and cross-sectional study was carried out by analyzing clinical records that had a complete medical history of patients between the ages of 3 and 79 years, with diagnoses of allergic rhinitis, asthma, and rhinoconjunctivitis. RESULTS: 1285 patients were studied; the frequency of positive skin reactivity for Prosopis was 27.78 %; 82.97 % had a diagnosis of allergic rhinitis, 4.39 % had a diagnosis of asthma, and 12.64 % had a diagnosis of rhinoconjunctivitis. CONCLUSIONS: Prosopis pollen plays an important role in diseases of allergic etiology. It is important to consider the antigenic combination with other families such as Chenopodiaceae.

Objetivos: Demostrar la reactividad cutánea y la participación del polen de Prosopis en los pacientes con enfermedades alérgicas que acuden al Servicio de Alergia e Inmunología Clínica del Hospital General de México, en la Ciudad de México. Métodos: Se llevó a cabo un estudio retrospectivo y transversal de expedientes clínicos que contaran con historia clínica completa, de pacientes entre tres y 79 años de edad con diagnósticos de rinitis, asma y rinoconjuntivitis alérgica. Resultados: Se estudiaron 1285 pacientes. La frecuencia de reactividad cutánea positiva para Prosopis fue de 27.78 %; 82.97 % cursaba con diagnóstico de rinitis alérgica, 4.39 % de asma y 12.64 % de rinoconjuntivitis. Conclusión: El polen de Prosopis participa importantemente en enfermedades de etiología alérgica. Es importante considerar el cruce antigénico con otras familias como las Chenopodiaceas.

Effect of BCG Revaccination on Occupationally Exposed Medical Personnel Vaccinated against SARS-CoV-2.

The production of specific neutralizing antibodies by individuals is thought to be the best option for reducing the number of patients with severe COVID-19, which is the reason why multiple vaccines are currently being administered worldwide. We aimed to explore the effect of revaccination with BCG, on the response to a subsequent anti-SARS-CoV-2 vaccine, in persons occupationally exposed to COVID-19 patients. Two groups of 30 randomized participants were selected: one group received a BCG revaccination, and the other group received a placebo. Subsequently, both groups were vaccinated against SARS-CoV-2. After each round of vaccination, the serum concentration of Th1/Th2 cytokines was determined. At the end of the protocol, neutralizing antibodies were determined and the HLA-DRB loci were genotyped. The participants from the BCG group and anti-SARS-CoV-2 vaccine group had increased serum cytokine concentrations (i.e., IL-1ß, IL-4, IL-6, IL-12p70, IL-13, IL-18, GM-CSF, INF-γ, and TNF-α) and higher neutralizing antibody titers, compared to the group with Placebo-anti-SARS-CoV-2. Twelve HLA-DRB1 alleles were identified in the Placebo-anti-SARS-CoV-2 group, and only nine in the group revaccinated with BCG. The DRB1*04 allele exhibited increased frequency in the Placebo-anti-SARS-CoV-2 group; however, no confounding effects were found with this allele. We conclude that revaccination with BCG synergizes with subsequent vaccination against SARS-CoV-2 in occupationally exposed personnel.

Molecular analysis of phenotypic interactions of asthma.

INTRODUCTION: Asthma is a heterogeneous disease characterized by multiples respiratory symptoms; this is a polygenic entity that involves a complex interaction of environmental factors and inherent to the individual. To understand the development of asthma, some phenotypes have been proposed. OBJECTIVE: This work's purpose was to explore different molecules related to asthma development and to define each phenotype's specific characteristics. MATERIAL AND METHODS: 96 adult patients diagnosed with asthma before any treatment were enrolled in the protocol. Spirometric parameters, circulating leukocytes, serum IgE, body mass index, exhaled nitric oxide (FENO), and leukotrienes (LTB4) in urine were determined in each patient. The presence of asthma phenotypes proposed by the Global Initiative for Asthma (GINA) were explored: A) Allergic asthma, B) Non-allergic asthma, C) Late-onset asthma, D) Asthma with persistent airflow limitation, and E) Asthma with overweight and obesity. RESULTS: In the cohort analyzed, we found four of phenotypes proposed by GINA; however, these phenotypes overlapped, due to this, 4 groups were integrated with allergic, non-allergic and obese patients, which were the main phenotypes. The main overlap was that of patients not-obese allergic, and was characterized by earlier onset, elevated levels of IgE, LTB4 and inflammasome related cytokines. Non-allergic patients had a significant association between interleukin (IL)-18 and IL-18 binding protein (BP) with narrow ratio between these cytokines. Finally, LTB4 had remarkable capacity to discriminate between allergic and not allergic patients. CONCLUSIONS: Asthmatic phenotypes exist as interrelated characteristics and not as discrete entities. High levels of leukotrienes and IgE are hallmarks in the allergic phenotype of asthma.

Identification of an allergenic calmodulin from Amaranthus palmeri pollen.

INTRODUCTION: Pollens are an important source of allergens that trigger rhinitis or asthma. The allergenic extracts of pollens used to diagnose and treat allergies contain different allergenic antigens. Isolated allergenic proteins are employed in in vitro assays, skin tests and allergenic-specific immunotherapy. Calcium-binding allergens are clinically relevant antigens, and their allergenicity can be affected by Ca2+ binding. In this work, a calmodulin was identified as an allergen from Amaranthus palmeri pollen, an important source of pollinosis in Europe, Asia and North America. MATERIALS AND METHODS: Allergenic calmodulin from A. palmeri pollen was isolated by size-exclusion chromatography and reverse-phase chromatography and identified by mass spectrometry. Sensitization to isolated calmodulin was evaluated by skin prick tests in patients with allergy to A. palmeri pollen. RESULTS: Size-exclusion chromatography yielded two fractions that were recognized by the IgE of patients allergic to A. palmeri pollen. Mass spectrometry analysis of the fractions from reverse-phase chromatography showed peptide sequences that identified a calmodulin. Skin prick tests showed that the isolated calmodulin was recognized by 56% of patients allergic to A. palmeri pollen. CONCLUSION: A. palmeri pollen calmodulin could be a clinically relevant allergen in patients sensitized to this source.

The cellular and humoral immune response to influenza vaccination is comparable in asthmatic and healthy subjects.

Annual influenza vaccination is recommended as a preventive measure for all patients with asthma since asthma exacerbations in children and adults are associated to viral infections including influenza. There is concern about the adequate immune response in asthmatics with ICS treatment. The production of antibodies to influenza in asthmatics has been demonstrated. However, cellular immunity is poorly understood. The aim of the study was to compare the humoral and cellular immune responses to influenza vaccine in asthmatic and healthy subjects. Twenty-five asthmatic patients attending the Allergy and Clinical Immunology Service at the Hospital General de Mexico and 25 healthy adults were included. Blood samples were obtained before, 4 and 12 months after immunization with influenza vaccine, influenza-specific antibodies were determined by the hemagglutination inhibition test and influenza-specific memory B, TCD4+, and TCD8 + lymphocytes were determined by flow cytometry. All the asthmatic patients received ICS treatment. The Geometric Mean titers for all influenza serotypes were similar in both groups; seropositivity and the cellular immune response increased in both groups over time and was comparable. Influenza vaccination in asthmatic patients with immunotherapy and ICS achieved protective antibody levels and cellular immunity over time comparable to healthy subjects.

[Hypersensitivity reactions to food additives]. / Reacciones de hipersensibilidad a aditivos alimentarios.

Food additives are ingredients that are intentionally added to food in order to modify its physical, chemical, biological, or sensorial characteristics. Food additives may act as allergens and generate IgE-mediated immune reactions, or they may act as pseudo allergens and generate non-IgE-mediated immune reactions. Such reactions can generate diverse clinical pictures or they may exacerbate diseases as diverse as eosinophilic esophagitis, bronchial asthma, atopic dermatitis, contact dermatitis, chronic urticaria, or anaphylaxis. Thousands of food additives are being used daily in industrialized countries and, although their use has been globalized, there is not much science information about their adverse effects; especially about their hypersensitivity reactions that, despite being reported in literature as rare, it is probably because they are under-diagnosed due to the fact that they require a high level of clinical suspicion by the physician, and the proof of a causal connection between the symptomatology and the food additive. Hypersensitivity reactions to food additives must be suspected in patients who report symptoms with the intake of multiple commercially prepared foods or to a commercially prepared food without presenting symptoms with the intake of the natural or homemade version of the same food or with the presence of idiopathic reactions. The diagnostic role of the in vivo or in vitro test against IgE (Skin Tests or RAST) is limited to some natural food additives. The gold standard diagnosis that shows causality between the additive and the symptoms is the oral food challenge. The treatment shall always be the elimination of the food additive from the patient's diet.

Los aditivos alimentarios son ingredientes agregados intencionalmente para modificar las características físicas, químicas, biológicas o sensoriales de los alimentos; pueden actuar como alérgenos y generar reacciones inmunológicas mediadas por IgE o como pseudoalérgenos y generar reacciones inmunológicas no mediadas por IgE. Dichas reacciones pueden provocar diversos cuadros clínicos o exacerbar diferentes enfermedades: esofagitis eosinofílica, asma bronquial, dermatitis atópica, dermatitis de contacto, urticaria crónica o anafilaxia. Diariamente, miles de aditivos alimentarios son utilizados en países industrializados y aunque su uso se ha globalizado, se dispone de poca información científica sobre sus efectos adversos, particularmente sobre las reacciones de hipersensibilidad, las cuales son raras en la literatura, muy probablemente porque son infradiagnosticadas debido a que requieren un alto grado de sospecha clínica por parte del médico y la demostración de una relación de causalidad entre la sintomatología y el aditivo alimentario. Las reacciones de hipersensibilidad a aditivos alimentarios deben ser sospechadas en paciente con reporten síntomas a múltiples alimentos o a un alimento de preparación comercial sin sintomatología ante la ingesta natural o casera del mismo o ante reacciones idiopáticas. El papel diagnóstico de la prueba in vivo o in vitro contra IgE (pruebas cutáneas o RAST) está limitado a algunos aditivos alimentarios naturales. La prueba diagnóstica que demuestra causalidad entre el aditivo y la sintomatología es el reto oral alimentario. El tratamiento deberá ser siempre la eliminación del aditivo de la dieta.

[Risk factors for uncontrolled asthma in adults]. / Factores de riesgo para mal control de asma en adultos.

BACKGROUND: Many studies in children had identified risk factors associated with partly or uncontrolled asthma. In adults, factors related to asthma control were not well defined. OBJECTIVE: To find the factors related to partly or uncontrolled asthma in adults. METHODS: Asthmatic adults who had severity at least in the mild persistent level, were recruited. The asthma control levels were classified as controlled, partly controlled and uncontrolled according to the Global Initiative for Asthma guideline. Risk factors were compared between the patients with controlled and partly controlled/ uncontrolled asthma groups. RESULTS: Two hundred (75.5 % females) were included. The mean age was 38.4 ± 11.93 years old. There were 100 patients (50 %) in the controlled and 100 patients (50 %) in partly controlled and uncontrolled asthma group. For asthma severity, 35 patients (88.2 %) were in mild persistent, 14 patients (10 %) in moderate persistent and 97 patients (1.8 %) in severe persistent groups. The absence of stress yielded an OR = 0.41 (95 % CI = 0.23-0.75), p = 0.03. While active smoking, OR = 4.23 (95 % CI = 1.35-13.2), p = 0.007. Patients who have no contact with stuffed animals or rugs have OR = 0.4 (IC 95 % = 0.2-0.79). It was important the result of the patients that if they correctly use their inhalers OR = 0.36 (IC 95 % = 0.13-0.97), p = 0.031. CONCLUSIONS: Current and active smoking and atopic dermatitis are risk factors. As a protective factor to the normal levels of eosinophils in blood, correct use of inhalers, FEV1 > 80 %, the absence of stress and the absence of contact with carpets and stuffed animals.

Antecedentes: Estudios en niños han identificado factores asociados con la falta de control del asma. En adultos no están bien definidos. Objetivo: Identificar los factores relacionados con la falta de control del asma en adultos. Métodos: Se incluyeron adultos con asma clasificados como controlados, parcialmente controlados y no controlados según los criterios de la Global Initiative for Asthma. Resultados: Se incluyeron 200 pacientes (75.5 % mujeres), edad promedio de 38.4 ± 11.93 años. Cien pacientes con asma controlada y 100 con asma no controlada y parcialmente controlada; 35 (88.2 %) con persistencia leve, 14 (10 %) con persistencia moderada y 97 (1.8 %) con persistencia grave; en estrés se encontró RM = 0.41 (IC 95 % = 0.23-0.75), p = 0.03; en tabaquismo actual y activo, RM = 4.23 (IC 95 % = 1.35-13.2), p = 0.007; y en uso correcto de inhaladores, RM = 0.36 (IC 95 % = 0.13-0.97), p = 0.031. Los pacientes no tuvieron contacto con peluches ni alfombras. Conclusiones: Se observó asociación con tabaquismo actual activo y dermatitis atópica. Como factores de protección se identificó niveles normales de eosinófilos en sangre, uso correcto de inhaladores, VEF1 > 80 %, ausencia de estrés y de contacto con alfombras y peluches.

[Non-allergic rhinitis with eosinophilic syndrome. Case report]. / Rinitis no alérgica con síndrome eosinofílico. Reporte de caso.

BACKGROUND: Rhinitis is the leading cause for consultation in the allergy department. It consists in chronic inflammation of the nasal mucosa. Non-allergic rhinitis with eosinophilic syndrome is characterized by chronic inflammation of the nasal mucosa (> 20% of eosinophils in nasal cytology) in the absence of demonstrable allergy (negative in vivo and in vitro tests); often it is accompanied by other sinonasal conditions (nasal polyposis, chronic rhinosinusitis), and it constitutes a risk factor for the development of obstructive sleep apnea. CASE REPORT: Seven-year old girl with rhinorrhea, nasal obstruction, nasopalatine itching, and severe sneezing that limited sleep and school activities. This condition had a seasonal pattern, with important blood (800 eosinophils/µL) and nasal (30%) eosinophilia and absence of demonstrable allergy (negative skin tests, negative specific nasal challenge tests); the non-allergic rhinitis with eosinophilic syndrome diagnosis was verified. CONCLUSIONS: Non-allergic rhinitis with eosinophilic syndrome is considered to be a highly underdiagnosed disease owing to the lack of in vivo nasal tests' performance; to this underestimation, incorrect nasal etiology and lack of local in vivo tests (nasal specific IgE) are added, which warrants a high degree of diagnostic suspicion by the specialist physician.

Antecedentes: La rinitis es la primera causa de consulta en el servicio de alergia. Se trata de una inflamación crónica de la mucosa nasal. La rinitis no alérgica con síndrome eosinofílico se caracteriza por eosinofilia crónica (> 20 % de eosinófilos en citología nasal) sin que pueda comprobarse la existencia de alergia (pruebas in vivo e in vitro negativas); frecuentemente se acompaña de otras enfermedades sinonasales (poliposis nasal, rinosinusitis crónica) y constituye un factor de riesgo para desarrollar apnea obstructiva del sueño. Caso clínico: Niña de siete años de edad con rinorrea, obstrucción nasal, prurito nasopalatino y estornudos de intensidad severa que limitaban sueño y actividades escolares, de patrón estacional con importante eosinofilia sanguínea (800 eosinófilos/µL) y nasal (30 %), sin alergia demostrable (pruebas cutáneas negativas y pruebas de provocación nasal específicas negativas); se comprobó el diagnóstico de rinitis no alérgica con síndrome eosinofílico. Conclusiones: La rinitis no alérgica con síndrome eosinofílico se considera una enfermedad altamente infradiagnosticada debido a la falta de realización de pruebas nasales in vivo. A la infravaloración se suma la incorrecta etiología nasal y la inexistencia de pruebas in vitro locales (IgE nasal específica), por lo que amerita un alto grado de sospecha diagnóstica por parte del médico especialista.

Tolerance Induction to Antituberculosis Drugs in a Patient With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap.

Tolerance induction and desensitization in Stevens-Johnson syndrome (SJS) or in toxic epidermal necrolysis (TEN) have been described as an absolute contraindication by some authors, but there are cases where there is no treatment alternative. Tuberculosis (TB) remains a leading cause of morbidity and mortality in developing countries and ranks alongside HIV as a leading cause of death worldwide. Severe drug reactions, such as SJS and TEN, occurring in these individuals are lifethreatening. Since alternative therapies for TB are limited, the role of desensitization and reintroduction becomes essential. We describe a case of tolerance induction to anti-TB drugs in a patient with SJS/TEN overlap syndrome using a specifically designed premedication, comedication, and desensitization protocol.

[Latex sensitization and allergy in Hospital General de Mexico surgery residents]. / Sensibilización y alergia a látex en residentes quirúrgicos del Hospital General de México.

BACKGROUND: The prevalence of latex allergy ranges from 0.8 to 6.5% and is the second cause of perioperative anaphylaxis. The main risk factors are being a health worker or latex producer, hours of latex gloves or products usage, exposure to other hand irritants, history of atopy, neural tube closure defects or numerous surgeries at early age. OBJECTIVE: To determine the frequency of latex sensitization in resident physicians of the Hospital General de México surgical area. METHODS: Prospective, cross-sectional, descriptive study where skin prick tests were applied to residents of the surgical area of the Hospital General de México, which depends on the Ministry of Health and is located in Mexico City. RESULTS: Ninety-two subjects were included and had skin tests practiced, with 11 surgical specialties participating. Latex sensitization in this population was 11.9%, whereas the presence of latex allergy was 10.8%. CONCLUSIONS: A high frequency of latex sensitization and allergy was demonstrated in Hospital General de Mexico surgery residents, which indicates the need for policies and procedures to be developed for health workers with latex allergy, as well as continuous training of employees on latex allergy.

Antecedentes: La prevalencia de alergia al látex oscila entre 0.8 y 6.5 % y es la segunda causa de anafilaxia perioperatoria. Los principales factores de riesgo son ser trabajador de la salud o productor de látex, horas de utilización de guantes o productos de látex, exposición a otros irritantes de manos, antecedente de atopia, defectos del cierre del tubo neural o numerosas cirugías a edad temprana. Objetivo: Determinar la frecuencia de sensibilización al látex en médicos residentes del área quirúrgica del Hospital General de México. Métodos: Estudio clínico prospectivo, transversal, descriptivo, mediante la realización de prueba de punción cutánea a residentes del área quirúrgica del Hospital General de México, Secretaría de Salud, Ciudad de México. Resultados: Se incluyeron 92 sujetos a los cuales se les realizó pruebas cutáneas, participando 11 especialidades quirúrgicas. La sensibilización al látex en esta población fue de 11.9 % y la presencia de alergia al látex de 10.8 %. Conclusiones: Se demuestró alta frecuencia de sensibilización y alergia al látex en los residentes quirúrgicos del Hospital General de México, lo que indica la necesidad de desarrollar políticas y procedimientos para los trabajadores de salud con alergia al látex y la capacitación continua de empleados sobre alergia al látex.

[Plantago psyllium-secondary anaphylaxis. Case report]. / Anafilaxia secundaria a plantago psyllium. Reporte de caso.

BACKGROUND: Psyllium is a derivative of Plantago ovata ground seed and husk that is used as bulk-forming laxatives owing to its hydrocolloid properties. CASE REPORT: 43-year-old female nurse with previous diagnosis of drug allergy and allergic rhinitis who, after the preparation and administration of a laxative, developed rhinoconjunctivitis symptoms, urticarial syndrome, angioedema and bronchospasm, which led to conclude that she had an anaphylactic reaction. She was treated with adrenaline, corticosteroids and antihistamines. After symptom resolution, with in vivo tests by means of the skin prick technique and by in vitro assay (specific IgE), hypersensitivity to plantago psyllium was determined. DISCUSSION: Most cases of anaphylaxis have been reported with psyllium ingestion, since, through that route, antigenic burden is higher. It should be noted that, even when exposure in the described patient was only by inhalation, manifestations were life-threatening.

Antecedentes: El psyllium es un derivado de la semilla y cáscara pulverizada de Plantago ovata, que se usa como laxante de volumen debido a sus propiedades hidrocoloides. Reporte de caso: Mujer de 43 años, de profesión enfermera, con diagnóstico de alergia a fármacos y rinitis alérgica, quien posterior a la preparación y administración de un laxante presentó síntomas rinoconjuntivales, síndrome urticariforme, angioedema y broncoespasmo, por lo que se concluyó que presentaba anafilaxia. Fue tratada con adrenalina, corticoides y antihistamínicos. Después de la resolución del cuadro, por pruebas in vivo mediante técnica de punción cutánea y por estudio in vitro (IgE específica) se determinó hipersensibilidad a plantago psyllium. Discusión: La mayoría de los casos de anafilaxia se ha reportado por ingestión de psyllium debido a que por esa vía es mayor la carga antigénica. Llama la atención la paciente descrita, en quien la exposición fue únicamente por inhalación, sin embargo, las manifestaciones que presentó fueron potencialmente letales.

[Perioperative allergy. A 3-year experience]. / Alergia perioperatoria. Experiencia de tres años.

BACKGROUND: Perioperative hypersensitivity reactions constitute a global health problem, with an estimated incidence of 1 per 100,000 procedures and a mortality rate of 0.1 to 9 %. Main risk factors are a history of allergy to other drugs, atopy, associated psychiatric disorders and previous surgeries. OBJECTIVES: To determine the frequency of sensitization and the type of drugs involved in perioperative allergy in a tertiary care hospital, over a 3-year period. METHODS: Retrospective, cross-sectional, descriptive study of perioperative allergy, corroborated by skin tests for each drug and latex, of patients treated at the Allergy and Clinical Immunology Department of Hospital General de Mexico. RESULTS: Twenty-eight patients diagnosed with perioperative allergy were included. Main triggers were neuromuscular blocking agents (46.42 %), latex (28.52 %) and propofol (14.28 %). The main risk factor was a history of previous surgeries (89.28 %). Most perioperative allergic reactions were mild (71.42 %) and occurred within the postoperative period (60.71 %). CONCLUSIONS: Initial diagnosis and Treatment should always be carried out by the anesthesiologist or surgeon, who should focus on the withdrawal of possible causative agents.

Antecedentes: Las reacciones de hipersensibilidad perioperatorias constituyen un problema de salud mundial, con una incidencia estimada de uno por cada 100 000 procedimientos y una tasa de mortalidad de 0.1 a 9 %. Los principales factores de riesgo son antecedentes de alergia a otros fármacos, atopia, trastornos psiquiátricos asociados y cirugías previas. Objetivos: Determinar la frecuencia de sensibilización y tipo de medicamentos implicados en la alergia perioperatoria en un hospital de tercer nivel, durante tres años. Método: Estudio retrospectivo, transversal, descriptivo de alergia perioperatoria corroborada mediante pruebas cutáneas a cada medicamento y al látex, de pacientes atendidos en el Servicio de Alergia e Inmunología Clínica del Hospital General de México. Resultados: Se incluyeron 28 pacientes con el diagnóstico de alergia perioperatoria. Los principales desencadenantes fueron los bloqueadores neuromusculares (46.42 %), el látex (28.52 %) y el propofol (14.28 %). El principal factor de riesgo fue el antecedente de cirugías previas (89.28 %). En su mayoría, las reacciones de alergia perioperatoria fueron leves (71.42 %) y se presentaron en el periodo posoperatorio (60.71 %). Conclusiones: El diagnóstico y tratamiento iniciales siempre deberán efectuarse por el médico anestesiólogo o el cirujano, enfocados en el retiro de los posibles agentes causales.

[Frequency of sensitization to aeroallergens in patients with seasonal and perennial allergic conjunctivitis]. / Frecuencia de sensibilización a aeroalergenos en pacientes con conjuntivitis alérgica estacional y perenne.

BACKGROUND: Allergic conjunctivitis is an inflammatory disease which involves the conjunctiva, its physiopathology is a type I hypersensitivity (IgE mediated). It is related to the sensitization to indoors and outdoors aeroallergens. Clinically it is classified as seasonal or perennial. It presents as ocular pruritus, conjunctival hyperemia, epiphora and photophobia. OBJECTIVE: To determine the frequency of sensitization to aeroallergens in patients with allergic conjunctivitis, seasonal and perennial, who attend the Allergy and Clinical Immunology Department at Mexican General Hospital Dr. Eduardo Liceaga. MATERIAL AND METHOD: A transversal and descriptive study was made in patients with seasonal and perennial allergic conjunctivitis. After informed consent, we obtained a complete clinical evaluation, laboratory studies and skin tests for aeroallergens. We determined the frequency of sensitization to those aeroallergens. RESULTS: We found sensitization most frequently to pollens such as Quercus, Alnus and Fraxinus, followed by Dermatophagoides spp. We had predominantly female patients of the second and fourth decades of life. CONCLUSIONS: Allergic conjunctivitis is a pathology frequently associated with allergic rhinitis. The most frequently involved allergens in this study were pollens and house dust mite.

Antecedentes: la conjuntivitis alérgica es una enfermedad inflamatoria que afecta directamente a la conjuntiva, la patogénesis de la conjuntivitis alérgica es predominantemente una reacción de hipersensibilidad tipo I mediada por IgE. Se relaciona principalmente con la sensibilización a aeroalergenos extra e intradomiciliarios. En términos clínicos se clasifica como estacional o perenne. El cuadro clínico consiste en prurito ocular, hiperemia conjuntival, epífora y fotofobia. Objetivo: determinar la frecuencia de sensibilización a aeroalergenos en pacientes con conjuntivitis alérgica estacional o perenne que acuden al Servicio de Alergia e Inmunología Clínica del Hospital General de México. Material y método: estudio transversal y descriptivo efectuado en pacientes con conjuntivitis alérgica estacional o perenne. Previo consentimiento informado, se realizó la historia clínica completa, así como estudios de laboratorio y pruebas cutáneas a aeroalergenos; se determinó la frecuencia de sensibilización a aeroalergenos. Resultados: se encontró con mayor frecuencia la sensibilización a pólenes de Quercus, Alnus y Fraxinus, seguidos de Dermatophagoides spp. Predominó el género femenino entre la segunda y cuarta décadas de la vida. Conclusiones: la conjuntivitis alérgica es una enfermedad frecuente asociada con rinitis alérgica. Los alergenos asociados con mayor frecuencia en este estudio fueron los pólenes y ácaros del polvo doméstico.

[Allergic bronchopulmonary aspergillosis]. / Aspergilosis broncopulmonar alérgica.

Allergic bronchopulmonary aspergillosis is a slowly progressive disease, caused by the fungus Aspergillus fumigatus hypersensitivity when it is found in the airway. It usually affects asthmatics and patients with cystic fibrosis. We report the case of a 20-year-old male patient, student, farmer and rancher with chronic respiratory disease. The diagnosis of allergic bronchopulmonary aspergillosis was made on the basis of the clinical symptoms and complementary studies.

La aspergilosis broncopulmonar alérgica es una enfermedad de progresión lenta, producida por la hipersensibilidad al hongo Aspergillus fumigatus cuando invade la vía aérea. Por lo general afecta a pacientes asmáticos y con fibrosis quística. Comunicamos el caso de un paciente de 20 años de edad, estudiante, ganadero y agricultor, con un cuadro respiratorio crónico. Luego del análisis de sus síntomas y de estudios complementarios, llegamos al diagnóstico de aspergilosis broncopulmonar alérgica.

[Sensitization to Casuarina equisetifolia and Pinus spp pollen in patients with allergic rhinitis and asthma in Mexico City]. / Sensibilización al polen de Casuarina equisetifolia y Pinus spp en pacientes con rinitis alérgica y asma en la Ciudad de México.

BACKGROUND: Pollinosis studies at Mexico City have found a considerable amount of Casuarina equisetifolia and Pinus spp pollen, its sensitization frequency is unknown. In Mexico, some allergens are not considered related to asthma or allergic rhinitis, even though reports in other countries have been demonstrated their relevance as aeroallergens. OBJECTIVE: To estimate the frequency of sensitization to Casuarina equisetifolia and Pinus spp pollen. PATIENTS AND METHOD: A transversal, descriptive trial was done at Hospital General de Mexico. Previous informed consent 142 patients with allergic rhinitis and asthma, 3 to 55 years old, were included to the study. A complete clinical evaluation, laboratory tests and skin prick tests were performed. RESULTS: We included 142 patients, 44 children (64% males) and 98 adults (73% females). We found that 8 (18.18%) children and 35 (35.7%) adults had a positive skin prick test to Casuarina equisetifolia. None of the patients included in the study had a positive skin prick test to Pinus spp. CONCLUSIONS: Sensitization to Casuarina equisetifolia is as important as other pollens found in Mexico City. These results suggest that it should be included when skin prick tests are performed. Pinus spp pollen is considered an aeroallergen in European countries but we did not corroborate sensitization in our population.

ANTECEDENTES: los estudios de polinosis efectuados en la Ciudad de México han encontrado una cantidad importante de polen de Casuarina equisetifolia y Pinus spp, la frecuencia de sensibilización a estos pólenes se desconoce. Estos alergenos no se han relacionado con asma bronquial o rinitis alérgica en México, a pesar de que estudios efectuados en otros países han demostrado su relevancia como aeroalergenos. OBJETIVO: determinar la frecuencia de sensibilización al polen de Casuarina equisetifolia y Pinus spp. PACIENTES Y MÉTODO: estudio transversal, descriptivo, efectuado en el servicio de Alergia e Inmunología Clínica del Hospital General de México. Previo consentimiento informado, se incluyeron 142 pacientes de 3 a 55 años de edad con diagnóstico de rinitis alérgica, asma o ambas. Se les realizó historia clínica completa, estudios de laboratorio, gabinete y pruebas cutáneas por punción. RESULTADOS: de los 142 pacientes, se incluyeron 44 niños (64% de sexo masculino) y 98 adultos (73% de sexo femenino). Se encontró que 8 (18.1%) niños y 35 (35.7%) adultos tuvieron reacción positiva en la prueba cutánea para Casuarina equisetifolia. Ninguno de los pacientes incluidos en el estudio tuvo reacción positiva a la prueba cutánea para Pinus spp. La frecuencia de sensibilización a Casuarina equisetifolia fue ligeramente menor a la de otros pólenes frecuentemente encontrados en la Ciudad de México. CONCLUSIONES: la sensibilización al polen de Casuarina equisetifolia es tan importante como la de otros pólenes encontrados en la Ciudad de México. Con estos resultados se sugiere que este polen se incluya en la práctica de pruebas cutáneas. El polen de Pinus spp es un aeroalergeno en países europeos. Sin embargo, en nuestra población no corroboramos la sensibilización al mismo.

[Pathophysiology and advances in the treatment of Hereditary Angioedema]. / Fisiopatología y avances en el tratamiento del Angioedema Hereditario.

Hereditary angioedema is an autosomic dominant disease, caracterized by recurrent angioedema and caused by a defective enzime known as C1 inhibitor. The main mediator involved in the development of angioedema is bradikynin. There are three types of the disease, the first one related to a decrease in the production of the enzime, the second one caracterized by an altered function of the enzime and the third one due to an altered factor XII gene. The recurrent angioedema may be localized in the periphery, in the gastrointestinal system or laryngeal, the last one being life threatening. For its treatment there are a lot of drugs available, such as attenuated androgens, fresh frozen plasma, tranexamic acid or the enzime substitution by a C1 inhibitor concentrate purified from plasma, nanofiltered or recombinant. Recently, treatment has been directed toward the avoidance of baradykinin production or its action through its B2 receptor.